Provider Demographics
NPI:1528762895
Name:SCRUGGS, KELLY ANNE MARIE (DO)
Entity type:Individual
Prefix:DR
First Name:KELLY
Middle Name:ANNE MARIE
Last Name:SCRUGGS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:620 RIVERSIDE DR APT 126
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43605-2178
Mailing Address - Country:US
Mailing Address - Phone:313-443-2411
Mailing Address - Fax:
Practice Address - Street 1:2109 HUGHES DR.
Practice Address - Street 2:JOBST TOWER 3RD FLOOR
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43606
Practice Address - Country:US
Practice Address - Phone:419-291-8154
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-29
Last Update Date:2023-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program